Individual
KAITLYN BEVACQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
99 BARK ST, TOMS RIVER, NJ 08753-1866
(732) 255-4014
Mailing address
99 BARK ST, TOMS RIVER, NJ 08753-1866
(732) 255-4014
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
46TR00630600
NJ
Other
Enumeration date
05/03/2015
Last updated
05/03/2015
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